Effect of Alcohol Dependency on Spouse

Effect of Alcohol Dependency on SpousePsychiatric distemperes are increasingly known to be common in the recent decades and affects over 25% of people at some point in a adults at any point in time, and at least one affected individual living in one every four families(1).Alcohol dependency syndrome is the maladaptive patters of alcohol inlet with tolerance craving, loss of control, and withdrawal symptoms (3).Bipolar affective disorder is episodic in nature with manic or hypomanic or depressive or mixed symptoms occur. Patients reveal fluctuating badness of any of these symptoms interspersed with a symptom free (euthymics 2) or subsyndromal periods.Cwvently the prevalence of bipolar affective disorder (BPAD) is around 0.4-0.5%with an 1 year prevalence of 0.5to 1.4% and a life-time prevalence of about 2.6 to 7.8% (4).The life-time prevalence of bipolar disorder is about 20.8 per 1000 population in India (6 ) and that of alcohol use ranges from 1.15% to upto 50% in everyday (8, 9).Burden Definition (10) PlattStigmatization, continuing emotional and economic burden from caring are endured by the families of individuals with psychiatric illness. The illness impact on the primary primary like providers leisure time activities work and social relationships. These deficits evoke different reactions infifferent or expressed emotional reaction towards the patients, and a sense of insufficiency and impuissance in themselves, all of which impact on the progression and prognosis of the patients illness (1).AIMTo compare the family burden, the quality of life and psychiatric unwholesomeness between female matchs of patients with alcohol dependence syndrome, patients with schizophrenia, and patients with bipolar affective disorderOBJECTIVESTo find the family burden and quality of life in female spouses of patients with alcohol dependence, schizophrenia and bipolar affective disorderTo evaluate the prevalence of psychiatric morbidity in female spouses of patie nts of these ternion groupsTo study the association between symptom severity in patients, perceived apathy, prodigious life events and family burden, and the quality of life and psychiatric morbidity in female spouses in these groupsTo compare psychiatric morbidity, family burden of care and quality of life in female spouses between all patient groups.MATERIALS AND METHODSThe sample is drawn from male patients with female spouses attending the outpatient Psychiatry department at this hospital.DesignCrosssectional, comparative study, including 64 patients with alcohol dependence, 64 patients with schizophrenia, and 64 patients with bipolar affective disorder, and their female spouses.With consecutive sampling from Outpatient department, a total of 192 patients with their spouses are taken up for the study.Duration and period of Study- 4 monthsInclusion criteriamale patients with equal to or more than 10 year duration of alcohol dependence or schizophrenia or bipolar affective diso rder, satisfying the criteria for the corresponding DSM IV-TR diagnosespatients with onset of psychiatric symptoms/disorder after marriagefemale spouses who provide care for the patientsparticipa nts should be non less than 60 years of ageparticipants to be willing to provide informed consent for the interview and assessmentpatients willing to allow spouse to be assessedExclusion criteriathose who did not give their consentrefusal to allow spouse to be evaluatedpatients and/or their spouses with any chronic general medical illnessspouses with a history of substance abuse, suicide or previous history of psychiatric symptoms and interventionspouses with a family history of psychiatric illnessspouses related to the patients by consanguinityInstruments used A semistructured profoma to collect the sociodemographic details, family history details and a semistructured clinical profileInternational Classification of Diseases ICD-10Shortform Alcohol Dependence Data Questionnaire SADDQClini cal orbicular Impressions CGI-BP bipolar andCGI-SCH schizophrenia, severity subduesPresumptive stressful life events scale PSLESApathy inventory caregiver versionBurden Assessment Scale BASCaregiver response Assessment -Selfesteem, High life-esteem -positive caregiving, Burnout -Negative Caregiving subscales CRASH-BOUNCE realiseWHO Quality Of Life WHOQOL BREF-1General Health Questionnaire GHQ-12MINI increase 5.0.0 v Mini International Neuropsychiatric Interview plusBeck Depression Inventory BDI Hospital Anxiety and Depression Scale anxiety HADS-ACGI-BPBipolar disorder is a cyclic and polymorphic disease. Patients may show manic, hipomanic, depressive or mixed symptoms, and they may be in partial or complete remission. For this reason, the assessment of the course, severity and outcome of the disorder is very complex. Most of the available psychometric instruments have been designed for the assessment of acute episodes of specific polarity.The CGI-BP-M, a user-friendly scale for the assessment of manic, hypomanic, depressive or mixed symptoms, and long-term outcome of bipolar disorder, is a useful tool for the assessment of the efficacy of several treatments.CGI-SAmongst the most widely used of extant brief assessmenttools in psychiatry, the CGI is a 3-item observer-ratedscale that measures illness severity (CGIS), globalimprovement or change (CGIC) and sanative response.The illness severity and improvement sections of theinstrument are used more oftentimes than the therapeuticresponse section in both clinical and research settings.Amongst the most widely used of extant brief assessmenttools in psychiatry, the CGI is a 3-item observer-ratedscale that measures illness severity (CGIS), globalimprovement or change (CGIC) and therapeutic response.The illness severity and improvement sections of theinstrument are used more frequently than the therapeuticresponse section in both clinical and research settings.Burden Assessment Schedule (BAS) (104) ANNEXURE IVI t is an instrument to assess burden on caregivers of chronic mentally ill. It was developed to assess subjective burden in Indian population, as many of the burden assessment instruments developed in the west were not culturally suited to Indian population.This schedule has 40 items and 9 domains. The different domains are Spouse related, Physical and mental health, External support, Caregivers routine, Support of patient, Taking responsibility, other(a) relations, Patients, Patients behaviour and Caregivers strategy.Each of these 40 items was rated on a 3-point scale marked 1-3. The responses were not at all, to some extent and very much. Depending on the questions were framed, the responses and the score for each(prenominal) of those responses would vary.In this study the schedule was modified by arranging 40- items into the above 9 domains. count score of each domain was calculated separately and at the end the total burden was calculated. This was done to suffer the domain s core apart from the total score. In the spouse was replaced with either son, daughter, brother, sister, mother or father, depending of the patient to the caregiver. In the items 2 and 4, the word sexual and marital was replaced by family as and when needed.The minimum total score of burden in BAS is 40 and the maximum score in 120. In this the severity of burden was categorized into 4 groups, in the following way,40-60 Minimum burden61-80 Moderate burden81-100 Severe burden101-120 truly severs burdenMethodConsecutive patients attending the Psychiatry OPDs of hospitals attached to J.J.M. Medical College, diagnosed as BPAD and Alcohol dependence according to DSM IV criteria who met the inclusion criteria and did not get excluded were included in the study.Written informed consent was taken from the patients or from the caregivers depending on their ability to give consent, following an explanation about the nature and the train of the study in the language in which the patient could understand. Sociodemographic details were recorded on the self designed proforma.The primary family care-giver was one who met at least three of the following criteria (108).Is a spouse, parent or spouse equivalent.Has the most frequent contact with the patient.Helps to support the patients financially.Has most frequently been collateral in the patients treatment.Is contacted by treatment staff in case of emergency.Burden Assessment Scale (BAS) was administered to assess the burden on caregivers of BPAD group and ADS group. Severity of alcohol dependence was assessed using Short Alcohol Dependence Data (SADD) Questionnaire.GHQValidityDiscriminative validityThere was a non-significant trend in GHQ Total loads and Depression subscalesscores to be higher for carers using Admiral Nurse (AN) teams vs. carers who did not(Woods et al., 2003). On follow-up, a significant difference was establish on the Anxietyand Insomnia subscale, where outcome was better for the AN group. Another study showed that carers of dementia patients showed higher levels of distress as measuredby GHQ than carers for patients with depression (Rosenvinge et al., 1998).Furthermore, significant differences in GHQ scores have been found between carersof people with anorexia and psychosis (Treasure et al., 2001). GHQ scores have alsobeen found to differ in carers of people with a head injury according to different timeintervals post-injury. The GHQ scores were higher for carers of people with a recenthead injury, which indicates greater burden in this group (Sander et al., 1997).Predictive validityCoping style has been found to contribute significantly to GHQ score variance, withemotion-focused coping being related to GHQ scores in a study by Sander et al.,(1997). Furthermore, coping accounted for more of the GHQ variance than disabilityscores.Socio-demographic variablesGender has been found to have a significant effect on GHQ scores, but neither racenor relationship to the injured person had a significant effect (Sander et al., 1997).Dimension-specific variablesStrong positive correlations were found between the GHQ and the Relatives StressScale (Draper et al., 1992).ResponsivenessThe GHQ-28 has been shown to be responsive to change in a study using cognitivebehavioural therapy in carers of Parkinsons disease patients. Both the Total score andthe scores for 3 of the sub-scales decreased in response to the intervention (Secker andBrown 2005). Both conventional and AN go led to lower GHQ scores overalland 2 of the 4 subscales over an 8-month period (Woods et al., 2003).